1
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Guimarães A, Gama J, Curvo-Semedo L, Manso AC. Crohn's disease and intestinal tuberculosis: challenging from every angle. BMJ Case Rep 2023; 16:e254400. [PMID: 38081731 PMCID: PMC10729158 DOI: 10.1136/bcr-2022-254400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
A woman in her 20s with a recent diagnosis of Crohn's disease (CD) affecting the ileocaecal valve was started on adalimumab, after routine tuberculosis (TB) tests were negative. Her abdominal symptoms got worse and she started presenting respiratory distress and fever. Tomography revealed a left pleural effusion, pneumonia and peritonitis with pelvic abscess. The diagnosis of disseminated TB with digestive involvement was suggested and sputum cultures were positive for Mycobacterium tuberculosis Treatment for TB was started and immunosuppressants discontinued, leading to respiratory improvement. Abdominal imaging was repeated, showing worsening signs of multisegmental ileal wall thickening, ileocaecal valve obstruction and a persistent pelvic abscess. She was then submitted to a laparoscopic ileocaecal resection for suspicion of worsening CD. Histopathology showed chronic ileocolitis compatible with CD and ganglionic tuberculosis, revealing the diagnosis of intestinal tuberculosis superimposed in CD. Recovery was uneventful.
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Affiliation(s)
- Andreia Guimarães
- General Surgery Department, Hospital and University Centre of Coimbra, Coimbra, Coimbra, Portugal
- University of Coimbra, Faculty of Medicine, Coimbra, Coimbra, Portugal
| | - João Gama
- Pathology Department, Hospital and University Centre of Coimbra, Coimbra, Coimbra, Portugal
| | - Luis Curvo-Semedo
- University of Coimbra, Faculty of Medicine, Coimbra, Coimbra, Portugal
- Medical Imaging Department, Hospital and University Centre of Coimbra, Coimbra, Coimbra, Portugal
| | - António Canaveira Manso
- General Surgery Department, Hospital and University Centre of Coimbra, Coimbra, Coimbra, Portugal
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2
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Da Cunha T, Patel S, Vaziri H. Colitis and Intestinal Granulomas in Acquired Immunodeficiency Syndrome. Clin J Gastroenterol 2022; 15:722-733. [DOI: 10.1007/s12328-022-01640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
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3
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Weng F, Meng Y, Lu F, Wang Y, Wang W, Xu L, Cheng D, Zhu J. Differentiation of intestinal tuberculosis and Crohn's disease through an explainable machine learning method. Sci Rep 2022; 12:1714. [PMID: 35110611 PMCID: PMC8810833 DOI: 10.1038/s41598-022-05571-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Differentiation between Crohn’s disease and intestinal tuberculosis is difficult but crucial for medical decisions. This study aims to develop an effective framework to distinguish these two diseases through an explainable machine learning (ML) model. After feature selection, a total of nine variables are extracted, including intestinal surgery, abdominal, bloody stool, PPD, knot, ESAT-6, CFP-10, intestinal dilatation and comb sign. Besides, we compared the predictive performance of the ML methods with traditional statistical methods. This work also provides insights into the ML model’s outcome through the SHAP method for the first time. A cohort consisting of 200 patients’ data (CD = 160, ITB = 40) is used in training and validating models. Results illustrate that the XGBoost algorithm outperforms other classifiers in terms of area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision and Matthews correlation coefficient (MCC), yielding values of 0.891, 0.813, 0.969, 0.867 and 0.801 respectively. More importantly, the prediction outcomes of XGBoost can be effectively explained through the SHAP method. The proposed framework proves that the effectiveness of distinguishing CD from ITB through interpretable machine learning, which can obtain a global explanation but also an explanation for individual patients.
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Affiliation(s)
- Futian Weng
- School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China.,National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361005, Fujian, China.,Data Mining Research Center, Xiamen University, Xiamen, 361005, Fujian, China
| | - Yu Meng
- Department of Gastroenterology and Hepatology, Shenzhen University General Hospital, Shenzhen, 518055, China.,Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen, 518037, China
| | - Fanggen Lu
- The Gastroenterology Department of Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Yuying Wang
- Data Mining Research Center, Xiamen University, Xiamen, 361005, Fujian, China.,School of Management, Xiamen University, Xiamen, 361005, Futian, China
| | - Weiwei Wang
- School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China.,National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361005, Fujian, China.,Data Mining Research Center, Xiamen University, Xiamen, 361005, Fujian, China
| | - Long Xu
- Department of Gastroenterology and Hepatology, Shenzhen University General Hospital, Shenzhen, 518055, China.,Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen, 518037, China
| | - Dongsheng Cheng
- School of Software Engineering, Shenzhen Institute of Information Technology, Shenzhen, 518172, China
| | - Jianping Zhu
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361005, Fujian, China. .,Data Mining Research Center, Xiamen University, Xiamen, 361005, Fujian, China. .,School of Management, Xiamen University, Xiamen, 361005, Futian, China.
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4
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Abstract
Inflammatory bowel disease (IBD) in recent times is causing a significant healthcare burden as both ulcerative colitis and Crohn's disease (CD) require lifelong therapy and constant monitoring. The current review highlights the concerns in a country like India with special reference to the changing trends of IBD, risk attribution and the financial issues. Indian immigrants behave like residential Indians, whereas their children show IBD prevalence similar to the West, highlighting the role of environmental triggers. However, the environmental and genetic factors in Indians with IBD are not well understood. Men appear to be more frequently affected than women in India. The disease severity is milder in the patients, both males and females, but the risk for colorectal cancer (CRC) is similar to the West. The incidence of paediatric IBD is on the rise. The major burden of IBD in the Indian subcontinent at present is in children, adolescents and teens. Cost towards the management of complications, non-adherence to treatment, differentiating tuberculosis from CD and finally screening for CRC in patients with IBD are the points to ponder in the Indian scenario.
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Affiliation(s)
- Mayank Jain
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, India
| | - Jayanthi Venkataraman
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, India
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5
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Using droplet digital PCR in the detection of Mycobacterium tuberculosis DNA in FFPE samples. Int J Infect Dis 2020; 99:77-83. [PMID: 32738487 DOI: 10.1016/j.ijid.2020.07.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/19/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Droplet digital PCR (ddPCR) is a technology that has higher sensitivity than real-time PCR for the identification of trace DNA. However, the use of ddPCR for the detection of Mycobacterium tuberculosis DNA in pathological samples has not been fully studied. METHODS A total of 65 formalin-fixed and paraffin-embedded (FFPE) specimens were included in this study. Twenty samples with definite results for tuberculosis (TB) were used to establish the ddPCR system for TB detection. ddPCR was then conducted to detect TB DNA in the 45 patients who were classified as 'possible TB' (real-time PCR results in the gray area, Ziehl-Neelsen staining-negative, and hematoxylin and eosin staining showing morphology suspicious for TB). The clinical treatment and disease outcomes were followed to assess the accuracy of ddPCR in the detection of TB DNA. RESULTS Among the 45 possible TB samples, 26 were ddPCR-positive, 12 were ddPCR-negative, and seven were in the gray area. ddPCR improved the positive rate of 57.8% (26/45) for the samples that were in the gray area by real-time PCR. Moreover, several patients received anti-TB therapy, and the effective ratio of therapy for the ddPCR-positive, ddPCR-negative, and ddPCR-gray area cases was 61.9% (13/21), 50.0% (2/4), and 33.3% (1/3), respectively. CONCLUSIONS ddPCR is more sensitive for detecting mild TB via FFPE samples than real-time PCR. The ddPCR method is of additional value in the diagnosis of TB from pathological samples.
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6
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Aggarwal N, Mahto SK, Singh A, Gupta K, Aneja A, Singh A, Goel A. Disseminated tuberculosis presenting as massive lower gastrointestinal bleeding. J Family Med Prim Care 2020; 9:1226-1228. [PMID: 32318501 PMCID: PMC7114054 DOI: 10.4103/jfmpc.jfmpc_1000_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022] Open
Abstract
Intestinal tuberculosis has varied clinical presentations and often requires high index of suspicion for clinching the diagnosis. We report a case of an 18-year-old male who presented with abrupt onset of massive lower gastrointestinal bleeding and was diagnosed to have ileocecal tuberculosis. This case signifies the need to consider the possibility of intestinal tuberculosis as a cause of severe hematochezia among other etiologies to prevent mortality and morbidity.
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Affiliation(s)
- Nehal Aggarwal
- Department of Medicine, Sucheta Kriplani Hospital & LHMC, New Delhi, India
| | - Subodh Kumar Mahto
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Akanskha Singh
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Kritika Gupta
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Ankita Aneja
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Anu Singh
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Atul Goel
- Department of Medicine, Sucheta Kriplani Hospital & LHMC, New Delhi, India
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7
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Liu T, Lu M, Chen B, Zhong Q, Li J, He H, Mao H, Ma H. Distinguishing structural features between Crohn's disease and gastrointestinal luminal tuberculosis using Mueller matrix derived parameters. JOURNAL OF BIOPHOTONICS 2019; 12:e201900151. [PMID: 31465142 DOI: 10.1002/jbio.201900151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 05/02/2023]
Abstract
Recently, the incidence of inflammatory bowel diseases, especially the Crohn's disease (CD) and gastrointestinal luminal tuberculosis (ITB), has grown rapidly worldwide. Currently there is no general gold standard to distinguish between CD and ITB tissues, which both have tuberculosis and surrounding fibrous structures. Mueller matrix imaging technique is suitable for describing the location, density and distribution behavior of such fibrous structures. In this study, we apply the Mueller matrix microscopic imaging to the CD and ITB tissue samples. The 2D Mueller matrix images of the CD and ITB tissue slices are measured using the Mueller matrix microscope developed in our previous study, then the Mueller matrix polar decomposition and Mueller matrix transformation parameters are calculated. To evaluate the distribution features of the fibrous structures surrounding the tuberculosis areas more quantitatively and precisely, we analyze the retardance related Mueller matrix derived parameters, which show clear different distribution behaviors between the CD and ITB tissues, using the Tamura image processing method. It is demonstrated that the Mueller matrix derived parameters can reveal the structural features of tuberculosis areas and be used as quantitative indicators to distinguish between CD and ITB tissues, which may be useful for the clinical diagnosis.
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Affiliation(s)
- Teng Liu
- Guangdong Research Center of Polarization Imaging and Measurement Engineering Technology, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of Optical Imaging and Sensing, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
- Department of Physics, Tsinghua University, Beijing, China
| | - Min Lu
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Binguo Chen
- Guangdong Research Center of Polarization Imaging and Measurement Engineering Technology, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of Optical Imaging and Sensing, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Qinsong Zhong
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jingyu Li
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Honghui He
- Guangdong Research Center of Polarization Imaging and Measurement Engineering Technology, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of Optical Imaging and Sensing, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Hua Mao
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Ma
- Guangdong Research Center of Polarization Imaging and Measurement Engineering Technology, Shenzhen Key Laboratory for Minimal Invasive Medical Technologies, Institute of Optical Imaging and Sensing, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
- Department of Physics, Tsinghua University, Beijing, China
- Center for Precision Medicine and Healthcare, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China
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8
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Dawani A, Gupta AK, Jana M. Imaging in Pediatric Extra-Pulmonary Tuberculosis. Indian J Pediatr 2019; 86:459-467. [PMID: 30697676 DOI: 10.1007/s12098-019-02858-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022]
Abstract
Extrapulmonary tuberculosis in children tends to be more severe than the adults. It can affect almost any organ system of the body. The clinical manifestations are often non-specific. Imaging findings are also not always very specific. This article describes the imaging spectrum of pediatric extrapulmonary tuberculosis.
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Affiliation(s)
- Anuradha Dawani
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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9
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Tuberculosis intestinal, simulador de la enfermedad de Crohn: diagnóstico diferencial. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:29-32. [DOI: 10.1016/j.gastrohep.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/28/2017] [Accepted: 01/07/2018] [Indexed: 01/29/2023]
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10
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Small Bowel Lesions Mimicking Crohn's Disease. Curr Gastroenterol Rep 2018; 20:43. [PMID: 30079433 DOI: 10.1007/s11894-018-0651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Not all injuries of the terminal ileum are Crohn's disease. It is the purpose of this review to consider the differential diagnosis of other acute and chronic ileal lesions. RECENT FINDINGS The recognition of a granulomatous disease of the terminal ileum, distinct from tuberculosis, dates back over 85 years and perhaps much farther, but over the past decades, many other clinical pathologic entities have been described that are neither tuberculosis nor Crohn's eponymous regional enteritis. In recent years, the catalog of lesions mimicking Crohn's disease of the small bowel and proposals for differential diagnosis and treatment have expanded to include newly reported appendiceal pathology, primary cancers and lymphomas of the intestine, unexpected metastases from distant organs, unusual infections, vasculitides and other ischemic conditions, Behçet's disease, endometriosis, and drug reactions. A diagnosis of Crohn's disease should not be a reflex action in the face of small bowel structural or inflammatory lesions without consideration of pathology in adjacent organs, primary and metastatic lesions of the small intestine, infections, vascular diseases, infiltrative diseases, drug injury, or other "idiopathic" conditions.
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11
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Diagnostic accuracy evaluation of the conventional and molecular tests for Spinal Tuberculosis in a cohort, head-to-head study. Emerg Microbes Infect 2018; 7:109. [PMID: 29921972 PMCID: PMC6008291 DOI: 10.1038/s41426-018-0114-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/28/2023]
Abstract
Early diagnosis of spinal tuberculosis (TB) is hampered by the flaws of conventional tests. The aim of this study was to assess the value of new and existing molecular tests in a prospective, head-to-head cohort study. Specimens were consecutively collected from spinal TB suspects in four hospitals in Beijing, China. Smear, culture, histopathology, Xpert MTB/RIF (Xpert), and MeltPro TB assays were performed in parallel using the same specimen from each patient. Drug-susceptibility testing (DST) was conducted on the isolates recovered. In total, 438 suspects were recruited; 319 of them were diagnosed with spinal TB according to the composite reference standard (CRS), which was composed of clinical, laboratory, histopathological, and radiological examinations and 18 months of follow-up. Based on conventional testing, 74.29% of patients were classified as confirmed cases, which increased to 90.6% when Xpert outcomes were integrated. Further, 76.60% of probable and 45.71% of possible cases were re-classified as confirmed cases with Xpert. Xpert (85.27%) produced higher sensitivity than histopathology (73.04%), MeltPro TB (57.68%), culture (51.72%) and smear (24.45%) (all P <0.001). Xpert was 100% concordant with phenotypic DST regarding rifampicin resistance detection. The sensitivity and specificity of MeltPro TB for rifampicin resistance detection were 100% and 97.96%, respectively, and 95.00% and 93.88% for isoniazid resistance detection. New molecular tests demonstrated excellent efficiency for spinal TB diagnosis in this cohort study, so their application as initial diagnostic tools would greatly increase the proportion of confirmed cases and dramatically reduce the delay of appropriate treatment. An updated laboratory testing algorithm of the disease is desirable.
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12
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Brown I, Kumarasinghe MP. Granulomas in the gastrointestinal tract: deciphering the Pandora's box. Virchows Arch 2017; 472:3-14. [PMID: 28776106 DOI: 10.1007/s00428-017-2210-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
Abstract
Granulomas are organised collection of activated histiocytes induced by a persistent antigen stimulus. A wide variety of antigens encountered by the gastrointestinal tract are of this nature and hence the resulting granulomatous inflammation represents a tissue reaction pattern. The potential causes can be broadly classified as infections or non-infectious immune reactions. There is also a group where a cause is never identified. Granulomas may be of varying morphological appearance, most commonly epithelioid, foreign body type, suppurative and necrotizing. This may provide a clue as to the aetiology; however, in most cases, the cause requires further inquiry. Pathologists may need to cut deeper levels to look for foreign material and apply special stains to look for microorganisms. Pathologists also need to be certain that the process is a true granuloma and not a mimic. The site of occurrence in the gastrointestinal tract and the clinical setting is often paramount in establishing the aetiology. For instance, infections are more likely the cause in developing countries or when there is immunosuppression. Similarly, granulomas in the stomach are usually due to Crohn's disease; however, it is only rarely the cause of granulomas isolated to the appendix.
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Affiliation(s)
- Ian Brown
- Envoi Pathology, 5/38 Bishop Street, Kelvin Grove, Brisbane, QLD, 4059, Australia. .,Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Marian Priyanthi Kumarasinghe
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia.,PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia
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13
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Ray G. Inflammatory bowel disease in India - Past, present and future. World J Gastroenterol 2016; 22:8123-8136. [PMID: 27688654 PMCID: PMC5037081 DOI: 10.3748/wjg.v22.i36.8123] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/09/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
There is rising incidence and prevalence of inflammatory bowel disease (IBD) in India topping the Southeast Asian (SEA) countries. The common genes implicated in disease pathogenesis in the West are not causal in Indian patients and the role of “hygiene hypothesis” is unclear. There appears to be a North-South divide with more ulcerative colitis (UC) in north and Crohn’s disease (CD) in south India. IBD in second generation Indian migrants to the West takes the early onset and more severe form of the West whereas it retains the nature of its country of origin in migrants to SEA countries. The clinical presentation is much like other SEA countries (similar age and sex profile, low positive family history and effect of smoking, roughly similar disease location, use of aminosalicylates for CD, low use of biologics and similar surgical rates) with some differences (higher incidence of inflammatory CD, lower perianal disease, higher use of aminosalicylates and azathioprine and lower current use of corticosteroids). UC presents more with extensive disease not paralleled in severity clinically or histologically, follows benign course with easy medical control and low incidence of fulminant disease, cancer, complications, and surgery. UC related colorectal cancer develop in an unpredictable manner with respect to disease duration and site questioning the validity of strict screening protocol. About a third of CD patients get antituberculosis drugs and a significant number presents with small intestinal bleed which is predominantly afflicted by aggressive inflammation. Biomarkers have inadequate diagnostic sensitivity and specificity for both. Pediatric IBD tends to be more severe than adult. Population based studies are needed to address the lacunae in epidemiology and definition of etiological factors. Newer biomarkers and advanced diagnostic techniques (in the field of gastrointestinal endoscopy, molecular pathology and genetics) needs to be developed for proper disease definition and treatment.
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14
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Sharma R, Madhusudhan KS, Ahuja V. Intestinal tuberculosis versus crohn's disease: Clinical and radiological recommendations. Indian J Radiol Imaging 2016; 26:161-72. [PMID: 27413261 PMCID: PMC4931773 DOI: 10.4103/0971-3026.184417] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Intestinal tuberculosis is a common clinical problem in India. The clinical features of this disease are nonspecific and can be very similar to Crohn's disease. Radiological evaluation of the small bowel has undergone a paradigm shift in the last decade. This long tubular organ that has traditionally been difficult to evaluate can now be well-visualized by some innovative imaging and endoscopic techniques. This article highlights the state-of-the-art evaluation of ulceroconstrictive diseases of the bowel and provides recommendations for the differentiation of intestinal tuberculosis from Crohn's disease.
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Affiliation(s)
- Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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15
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Che N, Qu Y, Zhang C, Zhang L, Zhang H. Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis. J Clin Pathol 2015; 69:600-6. [PMID: 26614787 DOI: 10.1136/jclinpath-2015-203244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/07/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND A pathological examination plays an important role in the confirmation of a diagnosis of tuberculosis, especially for smear- and culture-negative cases. However, conventional Ziehl-Neelsen staining and histological tests lack sensitivity and specificity. OBJECTIVE To evaluate the diagnostic value of immunohistochemical staining to detect Mycobacterium tuberculosis protein Ag85B and a newly developed double staining (ZC staining) method that can simultaneously detect acid-fast bacilli and M. tuberculosis antigen in the same histological section. METHODS A total of 282 formalin-fixed paraffin-embedded lung tissues were identified following histological examination, including 212 cases of pulmonary tuberculosis and 70 other pulmonary diseases. Ziehl-Neelsen staining, Ag85B-immunohistochemistry and the newly developed ZC staining were performed on serial sections of all the specimens. RESULTS Expression patterns of Ag85B were consistent with the distribution patterns of acid-fast bacilli. The signal produced by Ag85B-immunohistochemistry was much stronger than that produced by Ziehl-Neelsen staining. The sensitivity of Ag85B-immunohistochemistry was significantly higher than that of Ziehl-Neelsen staining, 53.8% (95% CI 47.0% to 60.5%) vs 34.4% (95% CI 28.0% to 40.9%). The newly developed ZC staining, integrating advantages of both Ziehl-Neelsen staining and immunohistochemistry, further improved the rate of sensitivity up to 65.6% (95% CI 59.1% to 72.0%). CONCLUSIONS This new method, detecting both acid-fast bacilli and M. tuberculosis antigen, is a simple and sensitive method for the pathological diagnosis of tuberculosis and can be easily incorporated into routine tests of pathological laboratories.
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Affiliation(s)
- Nanying Che
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yang Qu
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Li Zhang
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Haiqing Zhang
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
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16
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Danese S, Fiorino G, Mary JY, Lakatos PL, D'Haens G, Moja L, D'Hoore A, Panes J, Reinisch W, Sandborn WJ, Travis SP, Vermeire S, Peyrin-Biroulet L, Colombel JF. Development of Red Flags Index for Early Referral of Adults with Symptoms and Signs Suggestive of Crohn's Disease: An IOIBD Initiative. J Crohns Colitis 2015; 9:601-6. [PMID: 25908718 DOI: 10.1093/ecco-jcc/jjv067] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Diagnostic delay is frequent in patients with Crohn's disease (CD). We developed a tool to predict early diagnosis. METHODS A systematic literature review and 12 CD specialists identified 'Red Flags', i.e. symptoms or signs suggestive of CD. A 21-item questionnaire was administered to 36 healthy subjects, 80 patients with irritable bowel syndrome (non-CD group) and 85 patients with recently diagnosed (<18 months) CD. Patients with CD were asked to recall symptoms and signs they experienced during the 12 months before diagnosis. Multiple logistic regression analyses selected and weighted independent items to construct the Red Flags index. A receiver operating characteristic curve was used to assess the threshold that discriminated CD from non-CD. Association with the Red Flags index relative to this threshold was expressed as the odds ratios (OR). RESULTS Two hundred and one subjects, CD and non-CD, answered the questionnaire. The multivariate analysis identified eight items independently associated with a diagnosis of CD. A minimum Red Flags index value of 8 was highly predictive of CD diagnosis with sensitivity and specificity bootstrap estimates of 0.94 (95% confidence interval 0.88-0.99) and 0.94 (0.90-0.97), respectively. Positive and negative likelihood ratios were 15.1 (9.3-33.6) and 0.066 (0.013-0.125), respectively. The association between CD diagnosis and a Red Flags index value of ≥8 corresponds to an OR of 290 (p < 0.0001). CONCLUSIONS The Red Flags index using early symptoms and signs has high predictive value for the diagnosis of CD. These results need prospective validation prior to introduction into clinical practice.
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Affiliation(s)
- Silvio Danese
- IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Geert D'Haens
- IBD Unit, Gastroenterology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | | | - Julian Panes
- Gastroenterology Department, Hospital Clinic of Barcelona, IDIPABS, CIBERehd, Barcelona, Spain
| | - Walter Reinisch
- Medizinische Universität Wien, Klinische Abt. Gastroenterologie & Hepatologie, AKH Wien, Austria
| | - William J Sandborn
- Division of Gastroenterology, UC San Diego Health System, La Jolla, CA, USA
| | - Simon P Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
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Goldani LZ, Spessatto CO, Nunes DL, Oliveira JG, Takamatu E, Cerski CT, Goldani HAS. Management of Severe Gastrointestinal Tuberculosis with Injectable Antituberculous Drugs. Trop Med Health 2015; 43:191-4. [PMID: 26543395 PMCID: PMC4593777 DOI: 10.2149/tmh.2015-09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/03/2015] [Indexed: 12/29/2022] Open
Abstract
Abdominal tuberculosis (TB) is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. However, intravenous therapy is needed for severe forms of tuberculosis with extensive gastrointestinal involvement. The authors report an immunocompetent patient with gastrointestinal TB who was successfully managed with a combination of surgical intervention and anti-TB medications, and discuss the importance of injectable anti-TB medications in the management of severe gastrointestinal TB. The present case report provides a model for assessment and intervention in severe forms of gastrointestinal TB.
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Affiliation(s)
- Luciano Z Goldani
- Infectious Diseases Section, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Brazil
| | - Camila O Spessatto
- Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Brazil
| | - Daltro L Nunes
- Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Brazil
| | - Juliana G Oliveira
- Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Brazil
| | - Eliziane Takamatu
- Pediatric Surgery Section, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Brazil
| | - Carlos T Cerski
- Pathology Section, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Brazil
| | - Helena A S Goldani
- Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Brazil
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